pharm Chapter 17

Chapter 17: Immunologic System Medications

The Immune Response

• Antigen invasion and the body's defense actions:

  • Inflammation: Key role in limiting microbial spread.

  • First phase: Involves release of key substances:

    • Bradykinin: A vasodilator causing pain.

    • Complement: Proteins that destroy antigens.

    • Histamine & leukotrienes: Chemicals from mast cells causing smooth muscle contraction, blood vessel dilation, and itching.

    • Prostaglandins: Attract leukocytes and contribute to increased pain.

Second Phase of Immune Response

• Launches attack via antibodies secreted to combat antigens.

• B cells: Function as memory cells to guard against future attacks.

• T cells (CD cells): Produce cytokines that induce inflammation or attack invaders directly.

Medications Affecting the Immune System

• Types of medications:

  • Anti-inflammatory

  • Anti-infective

  • Antitoxin

  • Antifungal

  • Antiviral

  • Antiparasitic

  • Vaccines

  • Antineoplastic (chemotherapy)

Anti-Inflammatory Medications

• Function: Reduce inflammatory response.

• Treatment for autoimmune disorders includes:

  • Conditions: Rheumatoid arthritis, ulcerative colitis, Crohn’s disease, dermatitis, type 1 diabetes, multiple sclerosis, peptic ulcers, systemic lupus.

Allergies

• Overreaction to perceived threats (allergens) such as:

  • Pollen, dust, animal dander, cigarette smoke.

• Symptoms vary from mild (sneezing, watery eyes) to severe (anaphylactic shock).

Antihistamines

• Mechanism: Block histamine response, relax smooth muscles in respiratory, vascular, and GI systems.

• Examples:

  • Diphenhydramine (Benadryl)

  • Loratadine (Claritin)

  • Cetirizine (Zyrtec)

Glucocorticoids

• Characteristics: Steroid-like compounds that suppress inflammation.

• Forms:

  • Intranasal (e.g., Fluticasone)

  • Topical (e.g., Hydrocortisone)

  • IV (e.g., Methylprednisolone for severe inflammation).

• Important: Use prescribed dosage and taper off to prevent side effects.

Nasal Decongestants

• Purpose: Alleviate nasal congestion through vasoconstriction.

• Examples:

  • Nasal: Tetrahydrozoline (Tyzine Nasal)

  • Oral: phenylpropanolamine.

• Caution: Typically use for 3-5 days to prevent rebound congestion.

Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)

• Role: Reduce inflammation, antipyretic, and analgesic.

• Work by inhibiting prostaglandin synthesis.

• Examples: ibuprofen (Advil), naproxen (Aleve), celecoxib (Celebrex).

Immunosuppressants

• Use: Long-term therapy for inflammatory diseases.

• Examples:

  • Rheumatoid arthritis: azathioprine (Imuran)

  • Psoriasis: cyclosporine, sirolimus (Rapamune).

Anti-Infective Medications

• Classification: By action/structure (antibiotics, antivirals, antifungals).

• Target pathogenic processes in microorganisms.

Antibiotics

• Indications: Treat bacterial infections; categorized by shape, staining, and oxygen requirements.

• Drawbacks: Can disrupt normal flora, leading to super infections.

• Culture & Sensitivity tests: Identify effective antibiotics based on the bacteria.

Antibiotics - Penicillins

• Characteristics: One of the oldest antibiotics; effective against gram-positive and some gram-negative bacteria.

• Examples: Ampicillin, amoxicillin.

Antibiotics - Cephalosporins

• Similar to penicillin but more expensive; effective against gram-positive and gram-negative.

• Divided into four generations based on activity.

Antibiotics - Tetracyclines

• Actions: Prevent protein synthesis and effective against a range of infections.

• Caution: Not used in children/pregnancy due to potential for tooth staining.

Antibiotics - Macrolides

• Mechanism: Inhibit protein synthesis of microorganisms.

• Examples: Erythromycin, azithromycin.

Antibiotics - Aminoglycosides

• Toxicity: More toxic with monitoring required; reserved for when no alternatives are available.

• Examples: Gentamicin, neomycin.

Antibiotics - Quinolones

• Action: Bacteriostatic, preventing bacteria growth; reserved for resistant strains due to severe side effects.

• Examples: Ciprofloxacin.

Antibiotics - Sulfonamides

• Background: Early antibiotic class; interrupts bacterial metabolism.

• Examples: Trimethoprim-sulfamethoxazole.

Antituberculosis Agents

• Treatment for Mycobacterium tuberculosis; requires multiple medications for effectiveness.

• Examples: Rifampin.

Antitoxins

• Function: Antibodies counteract toxins in high-risk patients;

  • Example: Tetanus immune globulin.

Antifungal Medications

• Types: Used for superficial (e.g., athlete's foot) and systemic infections.

• Examples: Nystatin, fluconazole.

Viruses

• Minimal size, require host organisms to reproduce.

• Common viral infections: Influenza, herpes.

Antiviral Medications

• Primary action: Inhibit viral reproduction.

• Examples: Acyclovir, oseltamivir (Tamiflu).

Antiparasitic Medications

• Types include antimalarials, anti-protozoals, and anthelmintics, treated with respective specialized medications.

• Prevent growth or disrupt DNA strands of parasites.

Natural and Acquired Immunity

• Natural immunity occurs through normal body functions, while acquired immunity can be active or passive (artificial or natural).

Vaccines

• Designed to provoke memory B cells; side effects may include fever and pain at the injection site.

Cancer Overview

• Defined by uncontrolled cell division; can metastasize to other parts of the body.

Types of Tumors

• Benign: Non-cancerous, typically does not spread.

• Malignant: Cancerous, requires treatment to prevent fatal outcomes.

Antineoplastic Medications (Chemotherapy)

• Involves combination therapies tailored to individual cancers, can be administered in various ways including topical and injectable.

Side Effects of Chemotherapy

• Common adverse effects include nausea, vomiting, alopecia, and organ damage.